Explaining DGBIs in Practice: Language, Reassurance, and Integrated Care Strategies – With Amy Stewart, NP
What are DGBIs?
Disorders of gut-brain interaction are a group of chronic gastrointestinal conditions previously known as functional GI disorders.
These conditions are now understood to stem from dysregulation in the gut-brain axis – the bidirectional communication network between the enteric and central nervous systems.
This dysregulation can affect gut motility, sensation, immune function, and microbiota.
Common DGBIs include:
- IBS
- Functional dyspepsia
- Functional abdominal pain
- Centrally mediated abdominal pain syndrome
DGBIs are not caused by structural or biochemical abnormalities detectable on standard investigations. Instead, they reflect real, diagnosable changes in how the gut and brain communicate and regulate GI function¹.
Managing overlap and complexity
DGBIs often coexist with other gastrointestinal conditions, such as inflammatory bowel disease (IBD), gastroesophageal reflux disease (GERD), or coeliac disease.
In such cases, clinicians should consider whether:
- Structural causes have been adequately ruled out.
- Symptoms are disproportionate to objective findings.
- The symptom pattern aligns with a known DGBI, such as post-infectious IBS.
Further diagnostic evaluation may be warranted in the presence of red flags. However, once organic pathology has been excluded and symptoms persist, a diagnosis of DGBI should be made with confidence to guide timely intervention.
Supporting patients with multimodal care
Effective management of DGBIs is most successful when delivered through a multimodal approach and patients receive support from multiple angles:
This integrated approach addresses the complex gut-brain mechanisms driving symptoms while offering flexibility based on needs and preferences.
• Combines strategies that target symptoms through different pathways for a more comprehensive effect.
• Allows tailoring of interventions to each patient’s triggers, lifestyle, and goals.
• Enhances both short- and long-term outcomes by addressing the condition from multiple fronts.
• Helps patients understand that improvement is often the result of combined efforts, not a single therapy.
Translating AGA guidance into multimodal IBS treatment
The American Gastroenterological Association (AGA) now includes brain-gut behavior therapies like GDH and CBT in their quality guidelines for IBS management – recognizing them as essential components of evidence-based multimodal care.
This update addresses a frequent challenge in clinical practice: integrating behavioral therapies alongside diet and pharmacology as part of a balanced, guideline-based approach to IBS.
AGA quality indicators for IBS management
- Treatment with alosetron, eluxadoline, rifaximin, or tricyclic antidepressants (TCAs) should be considered in patients with IBS-D.
- Treatment with linaclotide, lubiprostone, plecanatide, tenapanor, or TCAs should be considered in patients with IBS-C.
- Avoidance of centrally acting opioids for IBS-related pain.
- Recognition of the gut-brain axis and performance or referral for brain-gut behavior therapies, such as cognitive behavioral therapy or gut-directed hypnotherapy.
- Dietary counseling (eg, increased soluble fiber or low fermentable oligo-, di-, mono-saccharide and polyol [FODMAP] diet) or referral to a dietitian.
By outlining both pharmacologic and non-pharmacologic options, these guidelines highlight where behavioral care fits into comprehensive IBS management and provide a clear framework for aligning treatment with current best practice.
Learn more about applying their recommendations here.
